Here at Advanced Skin Care and Dermatology Physicians, I see autoimmune diseases on a regular basis. The reason is due to classic findings or signs on the skin. As I’ve noted before, this is very important to recognize because, these signs could also point to other problems within the body.
In my first blog post about autoimmune diseases, I talked about lupus and listed some of the other diseases that may show up through skin findings. In the second blog post, I addressed two of the most common autoimmune diseases I see as a dermatologist: alopecia areata and vitiligo. In this third post, I will discuss two really important autoimmune diseases that have distinctive skin changes.
Scleroderma literally means “hard skin.” For reasons we don’t understand, the immune system takes up a war against the skin or internal organs that leads to abnormal deposits of collagen, a.k.a., scleroderma. It can be a very serious disease if advanced.
There are two major forms of scleroderma: localized scleroderma and systemic scleroderma. Localized scleroderma is called morphea and shows up on the skin as hard, waxy-looking areas. Often, there is a violet border around it that signifies it is active. But, this type of scleroderma is not associated with organ problems. Systemic scleroderma, on the other hand, means that the disease has the potential to “harden” other organ systems. Within this type, there is a “limited” and “diffuse” form. The limited form is called “CREST syndrome,” which stands for:
- C: Calcinosis is when alcium deposits happen in the skin.
- R: Raynaud’s: This occurs when the blood vessels on the fingers and toes spontaneously constrict in response to even minor changes in temperature or emotional stress. The skin turns white, then blue and then red. Sometimes these episodes are so severe that they can lead to ulcers or permanent death of some of the skin (gangrene).
- E: Esophageal dysmotility is when people may have trouble swallowing or digesting food.
- S: Sclerodactyly: Over time, due to hardening of the skin – mainly on the hands and feet, the fingers and toes contract and become difficult to use.
- T: Telangiectasias: Broken capillaries cover the skin over time. I see these all the time in people but, in scleroderma, they occur in clusters.
“Diffuse” systemic sclerosis is different than CREST syndrome and can have devastating effects on a wide variety of organs including the heart, lungs, kidneys and digestive system.
Dermatomyositis is an inflammatory autoimmune condition that can impact either children or adults. In most cases, it leads to severe muscle inflammation and muscle weakness. This is almost always accompanied by a rash that is very classic-looking and shows up around the eyes, hands, chest and thighs. It is more pronounced in areas that get sun and has a classic violet-looking color.
An uncommon condition associated with this is proximal muscle weakness, meaning weakness in the shoulders and hips. Though mostly uncommon, I do see it on a fairly regular basis. A family member of mine has it, which is one of the reasons I am so interested in this disease. Children get a specific type of dermatomyositis that can lead to painful calcifications in the muscles that can be extremely debilitating. It impacts adults in a different way that can affect other organs in the body as well. The main worry in adults with this disease is if they also have cancer. For some reason, this autoimmune condition can be a sign of an underlying cancer, so I always make sure people are up-to-date on their cancer screenings. However, kids that get this disease do not have an increased risk of cancer.
Have you had any experiences with these autoimmune diseases? We would love to hear your story in the comments.
Dr. Hayes – Board Certified Dermatologist
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